The Use of Anatomically Detailed
Dolls in Forensic Interviews

Forensic interviewers may use a variety of techniques when
interviewing young children about sexual abuse allegations. These
include anatomically detailed dolls, books, puppets, drawings,
projective cards, clay, games and toys (Conte, Sorenson, Fogarty, Rosa,
1991; Kendall-Tackett, 1992). The anatomically detailed dolls are
the most controversial; in fact the controversies over the dolls led to
the California courts banning information obtained in interviews when
the dolls were used (In re Amber B. and Teela B., 1987 and In re
Christine C. and Michael C., 1987).

Brief History of Research on Child Witnesses

To better understand the anatomical doll controversy, it is helpful to
review briefly the research on child witnesses. In the early part of
the 20th century, research on children's memory focused on children as
witnesses in court. Most of this research was conducted in Europe,
especially Germany and France. The area was little studied in the
United States until the 1920s and even then there were only a few studies
on child witnesses until the 1980s (Ceci & Bruck 1993, 1995). The
general conclusion from this research was that young children were
suggestible and vulnerable to making serious errors in their court
testimony (Ceci & Bruck, 1993, 1995; Goodman, 1984; Wakefield &
Underwager, 1988).

Following this early period, little research was done for years.
But then the increases in reports and allegations of sexual and physical
abuse led to changes in the legal system regarding the admissibility of
child witnesses' testimony (Ceci & Bruck, 1993, 1995; Goodman, 1984).
The requirement for corroboration of children's statements alleging sexual
abuse was dropped. Therefore, children's credibility, their
reliability as witnesses and their susceptibility to leading questions
became important to researchers and there are now hundreds of articles
addressing this issue. (For a review see Ceci & Bruck, 1995.)

During the beginning of this current period, it was often assumed that
young children were telling the truth and that false allegations of sexual
abuse were rare (i.e., Faller, 1984; Summit & Kryso, 1978).
Professionals often assumed that children did not lie about sexual abuse
and could not be "coached" to make false statements about important
central events such as sexual abuse. This sometimes resulted in
children's accounts of bizarre, improbable abuse being believed by adults.
Several highly publicized cases during the 1980s involving satanic, ritual
abuse allegations resulted in convictions, (e.g., deYoung, 1998; Nathan &
Snedeker, 1995).

During this time, a few forensic psychologists and psychiatrists began
to report on their analyses of child interviews (e.g., Coleman, 1986;
McIver, 1986; Underwager, Wakefield, Legrand, Bartz, & Erickson, 1986).
These early reports suggested that coercive questioning and suggestive
interview techniques could produce serious errors in a child's statements.
As academic researchers reviewed videotapes of actual interviews, they
began conducting studies that more closely approximated what happens in
the real world. These studies demonstrated conclusively that
children who were interviewed suggestively could produce false narratives
about fictitious events including central events. (For descriptions
of several of these studies, see Ceci & Bruck, 1995 and Poole & Lamb,
1998).

It is now understood that, although even very young children can
produce accurate, forensically useful information when they are
interviewed properly, suggestive questioning can lead them, and even older
children, to provide accounts of events that never occurred, even when
they first denied them (Bruck & Ceci, 1995; Ceci, 1994; Ceci & Bruck,
1993, 1995; Ceci, Loftus, Leichtman, & Bruck, 1994). Unfortunately,
despite the available knowledge about how to correctly interview children
(e.g., Bourg, 1999; Ceci & Bruck, 1995; Poole & Lamb, 1998; Orbach et al.,
2000; Yuille, Hunter, Joffe, & Zaprniuk, 1993; Work Group on Quality
Issues, 1997), many interviews in actual cases are suggestive and
contaminating (Underwager & Wakefield, 1990; Warren, Woodall, Hunt, &
Perry, 1996). It is within this context that the controversy over
the anatomically-detailed dolls has developed.

Anatomically Detailed Dolls

Anatomically detailed dolls are made of plastic or cotton and come
dressed with easily removable clothing. There are several commercial
manufacturers who sell the dolls but they are also sometimes handmade.
The mature female dolls have breasts that protrude and the boy and mature
male dolls have penises and scrotums. There are holes in the dolls
representing the mouth, anus and vagina. The penis is able to fit
into these openings. Often, the dolls have fingers that also fit
into the openings. The mature male and female dolls have simulated
pubic hair. Although some early versions of the dolls appear to have
genitals that are disproportionately large, a survey of 17 sets of
anatomical dolls (Bays, 1990) indicates that the genitals are not
exaggerated in size. The design of the dolls is not standardized and
there is considerable variation in the dolls available in the commercial
market (Simkins & Renier, 1996).

CRITICAL ANALYSIS

Children's Interactions with the Dolls

Several studies have examined the interactions of non abused children
with the anatomical dolls. The consistent conclusion from these
studies is that the behavior of children in interaction with the dolls
cannot be used to support a suspicion of sexual abuse. Although some
researchers claim the dolls are not necessarily suggestive (e.g., Everson
& Boat, 1994), some non-abused children put the dolls in sexual positions
or use them in other ways that may trigger suspicions of sexual abuse
(Boat, Everson, & Amaya-Jackson, 1996; Dawson & Geddie, 1991; Dawson,
Vaughan, & Wagner, 1992; Everson & Boat, 1990; Gabriel, 1985; Geddie,
Dawson, & Weunsch, 1998; Glaser & Collins, 1989; Herbert, Grams, &
Goranson, 1987; McIver, Wakefield, Underwager, 1989). Even Boat and
Everson, who support the use of anatomical dolls, note that non-abused
children frequently touch the dolls' genitalia and may even put the dolls
in clear sexual positions (Boat, et al., 1996). Bruck, Ceci,
Francoeur, & Renick (1995) found that half of their three year old
children who were given a physical that did not include a genital
examination falsely demonstrated genital or anal touching when questioned
with the dolls.

The behaviors of the children with the dolls are not reliable.
Boat, et al. (1996) interviewed 20 children twice, 16 months apart, and
found significant changes in the avoidant (avoiding any contact with the
unclothed dolls) and sexualized (placing the dolls in clear intercourse
positions) behaviors with the dolls. In addition, an interview with
the anatomical dolls has been found to increase later sexually focused
behavior in some children (Boat, Everson, & Holland, 1990).

The Use of the Dolls is Not Standardized

There are no accepted standards for the use of the dolls (APA Council
of Representatives, 1991; Koocher et al., 1995; Levy, Markovic,
Kalinowski, Ahart, & Torres, 1995). In the research studies using
the anatomical dolls, there is significant variability both in the
protocols used and in the definitions of sexual behavior (Elliot,
O'Donohue, & Nickerson, 1993; Simkins & Renier, 1996). Professionals
who use the dolls often fail to use any agency guidelines or protocols (Froum
& Kendall-Tackett, 1998) and are likely to develop personal norms based on
their own experience (Skinner, Berry, & Giles, 1992). Levy, et al.
(1995) found "wide variations in the extent to which interviewers and
observers agreed on various facets of the interview"
(p. 348).

Boat and Everson (1988) report that not only did few of the
professionals in their sample follow a set of guidelines, there were
disparities as to the types of doll interactions that the professionals
thought were evidence of sexual abuse. Some, for example, believed
that avoidance or anxiety about an unclothed doll constituted "very
convincing" evidence that the child had been sexually abused. Also,
the dolls that were used showed substantial variation (in features such as
having vaginal, anal and mouth openings and individual fingers) from
professional to professional. Kendall-Tackett and Watson (1992)
found that most (77.8%) of their respondents reported using a set of
guidelines, but a substantial minority did not. But even if all
interviewers used some type of guidelines, these guidelines are not the
same from agency to agency. There is no indication that using the
dolls enables the interviewer to get accurate information.

The Dolls May Be Leading and Suggestive, Especially if Used With
Leading Questions

The dolls are sometimes used in ways that can cause serious error in
the interview (Boat & Everson, 1996; Wakefield & Underwager, 1988, 1998;
Underwager & Wakefield, 1990). This can happen even if the dolls are
only used as an anatomical model to determine the names the child uses for
body parts. When the dolls are introduced prematurely or in
combination with inappropriate questions, they can be suggestive (Poole &
Lamb, 1998). When introduced early in the interview, the dolls can
focus the child's attention on genitals. If the child is instructed
to "pretend" with the dolls, this instruction may trigger the child into a
fantasy speculative world. Boat and Everson (1996) report that the
terms "play" or "pretend" were used in 28% of the interviews with 2 to 5
year olds and 9% of the interviews with 6 to 12 year olds. This
means that the interviewers risked encouraging the child to confuse
imaginary or playful scenarios with actual events.

The dolls may become learning experiences for a child when interviewers
model handling the dolls, undressing them or naming them for the child.
This is especially true if the interviewer asks the child to show with the
dolls what the accused person did or places the dolls in sexually explicit
positions. Bruck and Ceci (1995) note that "Anatomically detailed
dolls may serve as a nonverbal suggestive device which promotes subsequent
sexualized play and sexualized verbalizations, none of which are accurate
indictors of past abuse" (p. 293).

Very Young Children Have Developmental Limitations

A basic assumption underlying the use of the dolls is that they will
help a young child with limited verbal skills communicate information by
demonstrating with the dolls. Therefore, the dolls are seen as
particularly useful for preschool children (Yates & Terr, 1988). But
very young children cannot use one object to represent another.
Symbolic representation (the cognitive capacity to represent one thing by
another thing) is learned during the developmental process of the
individual from infant to adult (DeLoache, 1995a). It is not until
age 3 that children begin to understand and successfully use symbols.

Therefore, although adults may use the dolls in an attempt to overcome
a young child's verbal limitations, this may instead increase the
likelihood of error. DeLoache (1995b) examined this in a study with
preschool children. Three groups of children ages 2 1/2, 3 and 4
participated in a play session with a male experimenter that involved
touching the child and placing stickers on the child's body.
Afterwards, the children were asked where they had been touched and were
also asked to show where they were touched on the anatomical doll.
The youngest children had great difficulty with this task and were unable
to use the doll to show where the stickers had been placed on their
bodies. Children in all groups provided less information using the
doll than they did through talking or pointing at their own bodies.

The basic assumption for using the dolls is that children can show by
their behavior useful information they cannot talk about. This
assumption is also refuted by the research showing that we do not have
memories before we have the verbal skills to talk about them (Awh, et al.,
1996; Simcock & Hayne, 2002; Tessler & Nelson, 1996).

The Dolls Do Not Add Incremental Validity

Researchers have not found consistent differences between the
interactions of abused and non abused children with the dolls (Ceci &
Bruck, 1995). Studies that claim to show such differences have major
methodological shortcomings which limit any conclusions that may be drawn
from them (Ceci & Bruck, 1993; Skinner & Berry 1993; Underwager &
Wakefield, 1990, Wakefield & Underwager, 1988, 1989, 1994; Wolfner, Faust,
& Dawes, 1993). Abused and non-abused children in the research
studies are often not comparable in terms of economic background and
living situations. In the doll studies, the children suspected of
being abused tended to come from poor families living in poor
neighborhoods. In contrast, the control groups tended to consist of
children whose parents were willing to let them serve as subjects.
The two groups also differed as to whether the children had undergone an
abuse investigation including prior formal and informal interviews about
sexual abuse.

The anatomical dolls have no incremental validity (Wolfer, et al.,
1993). That is, they do not enable the interviewer to get additional
useful and valid information that adds to the information obtained from an
interview alone. Saywitz, Goodman, Nicholas, and Moan (1991) report
that the dolls did not often result in 5- and 7-year-old girls giving more
details of vaginal or anal touch. Lamb, Hershkowitz, Sternberg,
Boat, & Everson (1996) reported that children interviewed with dolls gave
fewer and less detailed responses to open ended questions than did the
children interviewed without dolls. In contrast, however, Leventhal,
Hamilton, Rekedal, Tebano-Micci, and Eyster (1989) found that more
detailed information was obtained when the doll interview was used and
that the use of the dolls increased the level of suspicion of abuse.
Wolfner et al. (1993), however, note that since the children's actual
abuse status was unknown in this study, there is no way to tell whether
the changes in conclusions about abuse were justified.

Most important, the research on the dolls does not address the crucial
Issue. The key problem is not to distinguish between children who
are known to be either sexually abused or non abused. Instead, the
task is to distinguish the children who have and who have not been abused
from a group of children who are all suspected of having been abused.

Therefore, the necessary research to determine whether the dolls
provide any incremental validity would involve a group of children who are
all suspected of being abused. Based on later evidence, these
children, all who are initially suspected to have been abused, could be
definitely divided into those who have and have not been abused. The
doll interviews would have to take place before the children are
interviewed by social workers and police officers, since the process of
being questioned about abuse could affect their reactions to the dolls.
Such research has not been done. (See Wolfner, et al. (1983) for a
discussion of incremental validity as it relates to the doll research.)

Even if the anatomical dolls produced useful information in addition to
what was obtained in an interview alone, this does not necessarily mean
that the professionals will properly interpret these data. Research
examining this issue was conducted by Realmuto and his colleagues
(Realmuto, Jensen, Wescoe, & Garfinkel, 1987; Realmuto, Jensen, & Wescoe,
1990). These researchers had an interviewer who did not know the
child's status use dolls to interview children known to have been abused
along with non abused control children. Neither the interviewer nor
three other professionals who reviewed the taped interviews did better
than chance in identifying which children had been abused on the basis of
the doll interviews.

Although Widely Used in the Field, the Dolls are Not Generally
Accepted in the Scientific Community

The anatomical dolls are often used by social workers and law
enforcement personnel in the field. But they are not accepted by
many scientists and other professionals who have conducted research on
interviewing child witnesses and formulated guidelines on how children
must be interviewed to obtain reliable and forensically useful
information. Therefore they cannot be claimed to be generally
accepted in the scientific community and are unlikely to meet the Frye
test.

Surveys since 1985 indicate that the dolls are used by large numbers of
police officers, social workers, and other professionals. Boat and
Everson (1988) found doll use ranging from 40% for law enforcement
officers to 94% for child protection workers. Kendall-Tackett and
Watson (1992) found that 62% of law enforcement officers and 80% of mental
health professionals in the Boston area used the dolls. Conte,
Sorenson, Fogarty, and Rosa (1991), in a nationwide survey of
professionals who "validated" child abuse allegations, found that 92% used
them. More recently, Davey and Hill (1999) reported that 36% of the
professionals in the United Kingdom used the dolls. The National
Center for the Prosecution of Child Abuse (Holmes, 2000) supports their
use and notes that the Hennepin County, Minnesota's child abuse evaluation
center, CornerHouse, routinely employs anatomical dolls in their child
interviews.

Because of the widespread use of the dolls by workers in the field it
may be claimed that the dolls are generally accepted. But the dolls
remain controversial in the scientific community. The American
Psychological Association took an equivocal position by acknowledging that
the dolls have no standardization, normative data, or uniform standards,
but still stating that they can be used (APA Council of Representatives,
1991; Koocher et al., 1995). The American Professional Society on
the Abuse of Children (APSAC, 1996) also said that the dolls and other
props could be used, but with care and discretion.

The position that the dolls my be used with care, however, does not
represent a consensus of the scientific community since a substantial
number of professionals and scientists are against their use (e.g.,
Bigelow, 2000; Bruck & Ceci, 1995; Ceci & Bruck, 1995; Fisher & Whiting,
1998; Gardner, 1992; Levy, 1989; Mason, 1991; Skinner, 1996; Skinner &
Berry, 1993; Underwager & Wakefield, 1990, 1995; Wakefield & Underwager,
1998; Wolfner, et al., 1993). Some of these scholars feel so
strongly that the dolls have no place in forensic interviews of children
that they question the ethics of using them as a way of determining
whether a child has been sexually abused (e.g., Fisher & Whiting, 1998;
Skinner & Berry, 1993; Wolfner, et al., 1993). In addition to
lacking general acceptance, the dolls do not meet Daubert standards
because they are not grounded on scientifically informed principles and
methodology. They are not reliable and they have no demonstrated
validity, that is, there is no indication that the dolls measure what they
are supposed to measure. There is no evidence that they help
investigators obtain accurate, truthful and forensically useful
information from the children they are interviewing.

RECOMMENDATIONS

The use of anatomical dolls in forensic evaluations remains
controversial. Although some professionals claim they are useful,
others argue that using the dolls risks compromising the accuracy of the
information obtained. Their use is especially problematic with very
young children or if the child's interaction with the dolls forms the
basis for a conclusion about sexual abuse. Some professionals
believe that the dolls can be used if great care is taken not to be
suggestive, if the child's interaction with the dolls is not the basis for
an opinion about sexual abuse and if they are not used with very young
children. Others, however, maintain that the dolls should not be
used at all, even with great care.

The dolls are not necessary with older children and risk introducing
error into the accounts of younger children. The level of error is
such that when a citizen's liberty interests are at stake great injustice
may be done by wrongful convictions. There is no empirical evidence
that doll interviews are a valid and a reliable method for getting
accurate information. The use of the dolls as an assessment or
investigatory technique is not generally accepted within the scientific
community, rather, their use remains highly controversial. The dolls
meet neither Daubert/Kumho Tire nor Frye requirements for admissibility.
Given this, we recommend:

Interviewers should use the techniques that are generally accepted in
the scientific community (e.g., Bourg, 1999; Ceci & Bruck, 1995; Poole &
Lamb, 1998; Orbach et al., 2000; Yuille, Hunter, Joffe, & Zaprniuk, 1993;
Work Group on Quality Issues, 1997). When interviewed properly, even
young children may be able to provide accurate and forensically useful
information.

Interviewers should not use the anatomically detailed dolls. They
are not useful in obtaining relevant information and may affect the
accuracy of what the child ultimately reports. They are
controversial and their use may result in the information obtained in the
interview being ruled inadmissible in court or being discredited by the
opposing attorney.

Attorneys should be familiar with the research on child witnesses and
the generally accepted guidelines for interviewing children in cases of
suspected sexual abuse.

If anatomical dolls have been used in a forensic interview, the
attorney must determine whether this may have compromised the reliability
of the interview and take the appropriate legal steps.

All investigatory interviews of child witnesses should be videotaped,
or at least audiotaped, since this is the only way the above can be
properly determined.

REFERENCES

APSAC (1996). Practice guidelines: Psychosocial evaluation of suspected
sexual abuse in children. Second edition. American Professional Society on
the Abuse of Children.

APA Council of Representatives (1991, February 8). Statement on the use
of anatomically detailed dolls in forensic evaluations. Washington: DC:
American Psychological Association.

Bigelow, B. J. (2000). On the assessment of children in suspected child
sexual abuse in light of Daubert and Frye: Limitations of profiles and
interviews as scientifically grounded evidence. Journal of Forensic
Sciences, May, 2000, 573-580.

Everson, M. D., & Boat, B. W. (1990). Sexualized doll play among young
children: Implications for the use of anatomical dolls in sexual abuse
evaluations. Journal of the American Academy of Child and Adolescent
Psychiatry, 29, 736-742.

Herbert, C., Grams, G., & Goranson, S. (1987). The use of Anatomically
Detailed Dolls in an Investigative Interview: A Preliminary Study of
"Non-abused" Children. Vancouver, British Columbia: Department of Family
Practice, University of British Columbia.

Underwager, R., Wakefield, H., Legrand, R., Bartz, C. S., & Erickson,
J. (1986, August). The role of the psychologist in the assessment of cases
of alleged sexual abuse of children. Presented at the 94th annual
convention of the American Psychological Association, Washington, DC.

Work Group on Quality Issues (1997). Practice parameters for the
forensic evaluation of children and adolescents who may have been
physically or sexually abused. Journal of the American Academy of Child
and Adolescent Psychiatry, 36(3), 423-442.

Yates, A., & Terr, L. C. (1988). Debate Forum: Anatomically correct
dolls: Should they be used as a basis for expert testimony. Journal of the
American Academy of Child and Adolescent Psychiatry, 27(2), 254-257.